Keywords: herd effect, incremental cost-effectiveness ratio (ICER), Markov transition-state model, pneumococcal disease, 13-valent pneumococcal conjugate vaccine (PCV13), 10-valent pneumococcal conjugate vaccine (PCV10)Pneumococcal disease causes large morbidity, mortality and health care utilization and medical and non-medical costs, which can all be reduced by effective infant universal routine immunization programs with pneumococcal conjugate vaccines (PCV). We evaluated the clinical and economic benefits of such programs with either 10-or 13-valent PCVs in Malaysia and Hong Kong by using an age-stratified Markov cohort model with many country-specific inputs. The incremental cost per quality-adjusted life year (QALY) was calculated to compare PCV10 or PCV13 against no vaccination and PCV13 against PCV10 over a 10-year birth cohort's vaccination. Both payer and societal perspectives were used. PCV13 had better public health and economic outcomes than a PCV10 program across all scenarios considered. For example, in the base case scenario in Malaysia, PCV13 would reduce more cases of IPD (C2,296), pneumonia (C705,281), and acute otitis media (C376,967) and save more lives (C6,122) than PCV10. Similarly, in Hong Kong, PCV13 would reduce more cases of IPD cases (C529), pneumonia (C172,185), and acute otitis media (C37,727) and save more lives (C2,688) than PCV10. During the same time horizon, PCV13 would gain over 74,000 and 21,600 additional QALYs than PCV10 in Malaysia and Hong Kong, respectively. PCV13 would be cost saving when compared against similar program with PCV10, under both payer and societal perspective in both countries. PCV13 remained a better choice over PCV10 in multiple sensitivity, scenario, and probabilistic analyses. PCV13s broader serotype coverage in its formulation and herd effect compared against PCV10 were important drivers of differences in outcomes.

OBJECTIVES: Influenza vaccination programs targeted at children have gained increasing attention in recent years. In the US, recommendations for influenza vaccination have expanded over the last decade to include all children aged 6 months to 18 years. However, in most other developed countries childhood influenza vaccination has been restricted to targeted programs for children at risk of influenza complications. METHODS: A literature search was conducted for English-language economic evaluations of influenza vaccination in those aged less than 18 years. Studies evaluating vaccination options exclusively targeted at specific risk groups were excluded. The literature search identified 20 relevant studies which were reviewed. RESULTS: The studies differed widely in terms of the costs and benefits that were included. All but one of the studies were conducted from a societal perspective. The majority of the studies included the value of lost productivity due to caregivers missing work to care for sick children. However, other forms of lost productivity were considered by some studies, including those resulting from being vaccinated, school absenteeism, premature death, and illness in caregivers. Only a small minority of studies also measured benefits in terms of non-monetised utilities such as quality-adjusted life years. Several evaluations, particularly those directly targeted at healthy children, did not include serious influenza complications. Only one of the reviewed studies used a dynamic transmission model able to fully incorporate the indirect herd protection to the wider population. CONCLUSIONS: The conclusions of the studies were generally favourable towards vaccination. Methodological decisions in terms of what costs and benefits to include appeared influential. Many studies applied a wider perspective (i.e. including productivity losses) than the reference case for economic evaluations used in many countries.

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